Fortunately, Angelina Jolie Isn't On Medicare

Most large private payers cover testing for a genetic marker indicating inherited breast cancer risk and will pay for prophylactic surgery. But Medicare has no national coverage decision for the test or for preventive mastectomy.

Last week 37-year-old Angelina Jolie, the actress, film director, and activist, kicked interest in genetic testing into overdrive when she announced that based on testing and her history of cancer, she had undergone a preventive double mastectomy.

A blood test showed that Jolie carries an inherited genetic mutation known as BRCA1, which increases her risk of developing breast and ovarian cancer. In a New York Times op-ed piece, Jolie wrote that the death of her mother at age 56 after a 10-year battle with cancer, combined with the BRCA results put her at an 87% risk of breast cancer and a 50% risk of ovarian cancer.

With the surgery she says her breast cancer risk factor is now less than 5%. She has opted to start with breast surgery, "as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex."

Among my first thoughts after reading Jolie's column was how fortunate the mega-star was to be able to self-fund the testing as well as the procedure. A spate of news articles grumbled that BRCA testing, which carries a $3,000 price tag, is not typically covered by insurers.

A 2011 study of the public and private coverage policies for BRCA testing published by the National Center for Biotechnology Information, however, offers some evidence to the contrary: Private payers are doing a pretty good job of providing coverage.

CPutnam (9/17/2014 at 9:42 PM)
Just like a man to comment on breasts. My sister has had breast cancer. Is a BRCA carrier. She only has Medicare to rely on. So they would rather she get cancer before they help her. ? Asinine.

Laurie (6/1/2013 at 6:30 PM)
@Grandma, I believe age is a risk factor for breast cancer in general. But, hereditary cancer is a different category [INVALID] tied to cancer at a young age (e.g., like Jolie's mother). This could be a legitimate reason why Medicare doesn't cover the prophylactic measures for BRCA gene positive women [INVALID] they should be done long before she reaches Medicare age, and, presumably, she's also likely to get that type of breast cancer before then as well.

Grandma (5/27/2013 at 12:25 AM)
Donald Stumpp, are you a doctor? Obviously not! The chances of a woman getting breast cancer gets greater as she gets older. Who are you to say Medicare shouldn't pay for the surgery? That is the insurance plan we have paid into all our lives and still pay a monthy premium for it.